Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy

Abstract

Patient: Male, 42Final Diagnosis: Gluteal compartment syndrome • acute peripheral nauropathySymptoms: —Medication: —Clinical Procedure: —Specialty: Critical Care MedicineObjective:Management of emergency careBackground:Heroin addiction is common, with an estimated 3.7 million Americans reporting to have used it at some point in their lives. Complications of opiate overdose include infection, rhabdomyolysis, respiratory depression and central or peripheral nervous system neurological complications.Conclusions:We present a 42-year-old male admitted after heroin use with heroin-related peripheral nervous system complication preceded by an acute gluteal compartment syndrome and severe rhabdomyolysis.Case Report:Early diagnosis and surgical intervention of the compartment syndrome can lead to full recovery while any delay in management can be devastating and can lead to permanent disability. The presence of peripheral nervous system injuries may portend a poor prognosis and can also lead to long term disability. Careful neurological evaluation for signs and symptoms of peripheral nervous system injuries is of paramount importance, as these may be absent at presentation in patients with opioid overdose. There is a potential risk of delaying a necessary treatment like fasciotomy in these patients by falsely attributing clinical symptoms to a preexisting neuropathy. Early EMG and nerve conduction studies should be considered when the etiology of underlying neurological weakness is unclear.

Bilateral sciatic neuropathy with severe rhabdomyolysis following venlafaxine overdose

“…In this patient, rhabdomyolysis occurred after taking venlafaxine, and it was assumed that additional muscular injury, including postural muscle compressions, may have occurred in the gluteal region while the patient was in an unconscious state and during her stay in the intensive care unit. [ 8 ] While the pressure of the gluteal compartment was not measured during the early days of hospitalization, this putative diagnosis was made with consideration of symptoms of pain, tenderness, and sensory depression of both thighs, as well as three-dimensional computed tomography and blood tests. The sciatic nerve does not pass through the fascial compartment, but is known to be vulnerable to swelling of the surrounding muscles as it passes under the gluteus maximus.…”

“…The sciatic nerve does not pass through the fascial compartment, but is known to be vulnerable to swelling of the surrounding muscles as it passes under the gluteus maximus. [ 8 , 9 ]…”

Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

“…The argument for conservative management is further buttressed by cases in the literature that report the use of fasciotomy in delayed presentations of GCS with no subsequent improvement in symptoms [ 15 , 16 , 22 ]. Furthermore, there is published literature that does not support fasciotomy in cases where necrotic tissue is likely to be present within the compartment [ 23 ].…”

Case study: Gluteal compartment syndrome as a cause of lumbosacral radiculoplexopathy and complex regional pain syndrome

“…While no major neurovascular structures course through the compartments themselves, an acute rise in pressure may cause damage by compressing the sciatic nerve where it courses between the gluteus maximus and the external rotator complex of the pelvis [5]. A common theme in the clinical histories of the reported cases is prolonged immobilization following drug abuse [6]. Less frequently, surgical positioning has played a role [3].…”